To help injured veterans, bring in private sector help

In all the brouhaha about the Veterans Administration — the alleged misconduct and malpractice in Arizona, and the ensuing calls for the head of Secretary Eric Shinseki — it is crucial that the issue not be treated solely as a referendum on Shinseki, and on the Obama administration generally.

The VA system is far too reluctant to ask for help from the private sector in caring for the hundreds of thousands suffering from the signature injuries of 21st century war: post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).

This is ironic, since it has been increasingly successful in getting veterans themselves to seek help with these challenges — which used to be so stigmatized that they often preferred to hide or ignore them.

It is true that the medical and therapeutic services of the Defense Department and the Veterans Administration have made many advances during these wars in Iraq and Afghanistan. The quality of prosthetic technology, for example, and associated rehabilitative programs have been greatly improved.

But the picture with mental healthcare in particular is not nearly so impressive. Here, the VA’s bureaucracy has dug in its heels against reform proposals to offer a combination of private and public healthcare.

The VA system still rejects ideas that could dramatically reduce the number of veterans on waiting lists to receive health care and veteran suicide rates that are at a modern-era high. Even as methods of care for PTSD and traumatic brain injury are rapidly improving,

The reason for the VA’s poor performance has less to do with Shinseki, who may even have favored some of the reform proposals, and more with VA career professionals. The culture is resistant to change — particularly to any change “not invented here.”

A proposal for public-private partnerships to treat PTSD and TBI would give veterans access to vouchers for treatment at any qualifying hospital in the nation — public or private, VA or not. The participating hospitals should include the best teaching and clinical hospitals, because they have the capacity and sophistication to make a serious difference. They’re more likely to develop advances to treat the brain injuries that can ravage the quality of life of veterans and their families than the stagnant VA. They can also make a difference in addressing the enormous healthcare backlogs we have today through their sheer size. Otherwise, those backlogs are unlikely to disappear, even as the Afghanistan conflict winds down.

Shinseki has been unable to make meaningful changes. After years of bureaucratic resistance, a 2012 executive memorandum from the White House took steps to allow a greater role for non-military hospitals in addressing this PTSD and TBI epidemic. Joint research efforts into the best treatment methods for these brain injuries were initiated as public-private partnerships. In addition, a pilot program allowing up to 20 non-military hospitals in remote rural areas to treat wounded warriors was authorized.

While welcome, these efforts do not go nearly far enough. The research agenda is reasonable. But adopting only a pilot approach to public-private partnerships, a dozen years into the nation’s current wars, is unconscionable. If the idea is a sincere effort to try out new methods to see if they work, where is the data on how well the program is working so far? Military analysts have looked for it in the public domain, without success.

Worse, where is the sense of urgency? By the time this pilot program is assessed, it will likely be too late to reach the majority of suffering veterans before the most acute phase of the current veterans challenge has passed.

The solution is simple. Any veteran qualifying for treatment of PTSD or TBI should immediately have the option of seeking therapy within the VA system or outside — with the government footing the bill either way. Doing so will spark innovation and healthy competition that will lead to better care for our nation’s wounded soldiers, sailors, Marines, airmen and airwomen.

Shinseki is a remarkable military leader with a decades-long record of command and bravery. That said, however, a degree of accountability is appropriate and some degree of partisan debate inevitable. Whether Shinseki survives the scandal or not, we must assess where we now stand in veterans’ care and determine what challenges any future Veterans Administration secretary will have to tackle.

PHOTO (TOP): A pileup of claims at the Department of Veterans Affairs facility in Roanoke, Virginia, is shown in this undated photo. REUTERS/Government Handout

Conservatives will use problems at the Veterans Administration to promote their ideologies, regardless of the disconnect between their solutions and the actual problems. The current issue is that backlogs of eligibility determination are slowing the entrance of needy vets into the VA health care system. Mr. O’Hanlon ignores this centrality because privatizing veteran’s care offers no solutions to this.

When asked if they would use a VA medical center the next time they need inpatient or outpatient care, veterans in the 2013 American Customer Satisfaction Index (ACSI) survey overwhelmingly indicated that they would (96 and 95 percent, respectively). These approval ratings are higher than any of the private health care systems which Mr.O’Hanlon champions.

VA hospitals and clinics have by far the most experience in treating veteran-specific injuries such as occur in combat. To assert that they would get equal or superior care in the local storefront clinic or small town hospital is absurd on its face. Beware the proscriptions of ideologues.

Any veteran qualifying for treatment of PTSD or TBI should immediately have the option of seeking therapy within the VA system or outside — with the government footing the bill either way. Doing so will spark innovation and healthy competition that will lead to better care for our nation’s wounded…

We’ve heard this same privatization argument before. While I totally agree that the current VA system is not providing the best care for veterans, I do not agree that allowing them unfettered private healthcare will necessarily lead to “healthy competition”. True, private healthcare providers will flock to the new cashcow – treatment for veterans at maximum price since the government will be “footing the bill either way”.

My suggestions is to automatically enroll veterans in a Vet Medicare program rather than using an individual voucher system. At least that will provide better prices for the treatment.

The only problem with this ‘Op-Ed’ piece, is that it doesn’t go far enough. Yes, the guys with PTSD and TBI are badly in need of care, but so are many who received other combat related wounds. Getting accepted at a VA facility is a crap shoot at best. Under strict orders to deny as many veterans as possible, these budget depraved administrators will do anything to keep benefits from vets… Its a system wide problem, and always has been.

I agree with edgyinchina, but would go further and into more detail. With the Affordable Care Act at least partially in place, we should start moving toward eliminating the VA and integrating ALL the services into the same system as the rest of us use. We’d still pay for their treatment costs, like in the VA, but the veterans would be visiting the same hospitals as everyone else. Seeing their neighbors perhaps or friends. There is no reason to continue to have two parallel systems in order to provide quality care to our vets. I think our vet would get better and faster care this way.

Besides the cost savings of having one system instead of two systems running in parallel, there would be the benefit of all walks of life socializing with the vets in the waiting rooms. Non-vets would have the opportunity to learn what our vets have to go through, and the vets might receive emotional support; this time from a different source.

I agree with @bryanric, as long as we have health coverage for all, then we do not need the uber expensive VA. The government can pay veterans premiums and copays instead. Even provide a serve to help them get insurance.